Effectiveness of photobiomodulation therapy for nipple pain or nipple trauma in lactating women: a systematic review protocol.

OBJECTIVE: The objective of this protocol is to evaluate the effectiveness of photobiomodulation therapy for the treatment of nipple pain or nipple trauma in women during the breastfeeding period. INTRODUCTION: One approach that has been reported on the management of nipple pain or nipple trauma in lactating women is the use photobiomodulation therapy to heal the injury or to decrease pain intensity. However, studies have achieved different results, due to variations in the treatment protocol, such as the source of light used, the application mode, the irradiation, or the light dose parameters, leading to varying outcomes. INCLUSION CRITERIA: This review will consider studies that evaluate photobiomodulation therapy for the treatment of nipple pain or nipple trauma in lactating women in the postpartum period that compare the intervention to standard care, placebo, or other type of treatment. The following outcomes will be considered: intensity of nipple pain, healing of nipple trauma, exclusive breastfeeding rate, quality of life, and satisfaction of the women with treatment. There will be no publication time limit, and studies published in any language will be considered for inclusion. METHODS: This review will be conducted in accordance with JBI methodology for systematic reviews of effectiveness. The search strategy will search both published and unpublished studies, and the process of study selection, critical appraisal, data extraction, and data synthesis will be performed in accordance to the JBI approach. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019147401.

Prevention and management of primary postpartum hemorrhage among puerperae in a teaching hospital in São Paulo, Brazil: a best practice implementation project.

OBJECTIVES: The aim of this project was to develop and implement strategies to promote standardization and formal documentation of increased bleeding within the first 24 h after birth, in compliance with best practice. INTRODUCTION: Official data from Brazil shows a maternal mortality rate of around 52 to 75 deaths per 100,000 live births, 8% of which are caused by hemorrhage. Early diagnosis is promoted through standardization and formal documentation of the first signs of hemorrhage. METHODS: The current implementation project used the Joanna Briggs Institute Practical Application of Clinical Evidence System, a baseline audit was conducted on a sample size of 108 patients and 67 nursing staff. Based on the results of the baseline audit, strategies to address non-compliance were developed and implemented. A follow-up audit was conducted on a sample size of 110 patients and 68 nursing staff, using the same audit criteria. RESULTS: The baseline audit showed poor compliance with evidence-based best practice in every criterion. The implemented protocol for postpartum hemorrhage was well received by the nursing staff, promoting early diagnosis of increased bleeding within 24 h after birth and providing support for further medical treatment. There were significant improvements in every best practice criterion in the follow-up audit. CONCLUSION: The current implementation project managed to improve the nursing staff professional practice, reducing the absence of records while promoting greater awareness of the first signs of primary postpartum hemorrhage.

Interventions to reduce patient identification errors in the hospital setting: a systematic review protocol.

REVIEW QUESTION: The question of this review is: how effective are the interventions that may prevent or reduce patient identification errors in the hospital setting?

Falls prevention strategies for adult inpatients in a university hospital of São Paulo, Brazil: a best practice implementation project.

OBJECTIVES: The main objective of this project was to reduce the incidence and harm from falls that occur among patients admitted in the acute Internal Medicine Unit and Intensive Care Unit in a public teaching hospital in São Paulo, Brazil. INTRODUCTION: Falls are a challenge for health professionals and healthcare services as they may result in high-impact outcomes for patients, such as functional decline, increase in length of hospital stay, increase in the cost of healthcare services, and death. In an attempt to promote safe care the World Health Organization (WHO) launched the World Alliance for Patient Safety in 2004 that encourages the adoption of best practice to reduce adverse events in healthcare services. METHODS: The project used the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in health practice. A baseline audit was conducted measuring eight best practice criterias, followed by the implementation of target strategies and a follow-up audit. RESULTS: The results of the baseline audit identified large gaps between current practice and overall compliance with best practice. The GRiP module helped identify strategies related to education programs for patients, families and nursing teams, and a falls risk assessment with an accurate tool to address the gaps in compliance. The follow-up audit cycle was satisfactory as all best practice audit criteria showed an improvement as an aggregated result. CONCLUSIONS: The project used the audit and feedback strategy to translate evidence into practice. Some of the measured criteria improved to moderate-high compliance with best practice. The results showed that implementation of evidence-based practice leads to an improvement in falls prevention. Future audits are required to sustain improvements.

Central line bundle maintenance among adults in a university hospital intensive care unit in São Paulo, Brazil: a best practice implementation project.

OBJECTIVES: This implementation project aimed to identify the current practice in regards to central venous catheters (CVCs) maintenance to improve knowledge amongst nursing staff and to assess increased compliance with evidence-based best practice. INTRODUCTION: Central venous catheters are considered an important therapeutic resource for the administration of fluids, drugs, blood, collection of blood samples and hemodynamic monitoring. Despite the benefits, catheter use is associated with complications such as primary infection of the catheter-related bloodstream. METHODS: This project utilized the audit and feedback model using the Joanna Briggs Institute Practical Application of Clinical Evidence System. Nine of 10 criteria were audited through direct observation of nursing professionals or patient records in relation to CVC maintenance, and one criterion involved direct questioning of nursing staff. Baseline and follow-up audits were conducted in a 12-bed adult intensive care unit in a university hospital. RESULTS: The baseline audit revealed deficits between current practice and best practice in some criteria. Barriers to implementation of CVC maintenance best practice criteria were identified, and the strategies were implemented. The post-implementation (follow-up) audit showed improvement in compliance to best practice guidelines in all of the audit criteria, except in one criterion: the use of sterile gloves or surgical tweezers during the execution of the dressing. CONCLUSIONS: Best practice in CVC care was achieved in the hospital, strengthening and guiding nursing care, as well as highlighting the importance of nursing records throughout the care process. However, this project highlighted the need to improve compliance through follow-up audits and periodic training to support best practice.

Nasoenteric feeding discharge planning for cancer patients in a Brazilian teaching hospital: a best practice implementation project.

OBJECTIVES: The objective of this project was to improve local practice in nasoenteric feeding discharge planning for cancer patients in a cancer teaching hospital in São Paulo, Brazil. INTRODUCTION: Nasoenteric tubes are commonly used for enteral nutrition in patients with cancer for over seven days during their recovery and this may be continued at home, with clear benefits. RESULTS: Baseline audit results indicated poor compliance (between 0% and 22%) with the current evidence, although good compliance (100%) was observed for three audit criteria. Implementation of the strategies, including changes to achieve higher participation of caregivers, resulted in an improvement of the audited criteria (100% compliance was maintained for three criteria, compliance increased from 22% to 67% for a further three criteria, with 0% compliance for one criterion). CONCLUSIONS: Despite the short time frame of this study, an increase in compliance with best practices proposed by the Joanna Briggs Institute was observed. Implementing a multidisciplinary meeting before patient discharge remains a challenge.

Implementation of evidence-based practices in normal delivery care.

OBJECTIVE: to evaluate the impact of the implementation of evidence-based practices on normal delivery care. METHOD: quasi-experimental, before-and-after intervention study conducted in a public maternity hospital, Amapá. Forty-two professionals and 280 puerperal women were interviewed and data from 555 medical records were analyzed. The study was developed in three phases: baseline audit (phase 1), educational intervention (phase 2) and post-intervention audit (phase 3). RESULTS: after the intervention, there was an increase of 5.3 percentage points (p.p.) in the normal delivery rate. Interviews with the women revealed a significant increase of the presence of companions during labor (10.0 p.p.) and of adoption of the upright or squatting position (31.4 p.p.); significant reduction of amniotomy (16.8 p.p.), lithotomy position (24.3 p.p.), and intravenous oxytocin (17.1 p.p.). From the professionals' perspective, there was a statistical reduction in the prescription/administration of oxytocin (29.6 p.p.). In the analysis of medical records, a significant reduction in the rate of amniotomy (29.5 p.p.) and lithotomy position (1.5 p.p.) was observed; the rate of adoption of the upright or squatting position presented a statistical increase of 2.2 p.p. CONCLUSIONS: there was a positive impact of the educational intervention on the improvement of parturition assistance, but the implementation process was not completely successful in the adoption of scientific evidence in normal delivery care in this institution.

Implementation of evidence-based practices in normal delivery care / Implementação das práticas baseadas em evidências na assistência ao parto normal / Implementación de las prácticas basadas en evidencias en la asistencia al parto normal

ABSTRACT Objective: to evaluate the impact of the implementation of evidence-based practices on normal delivery care. Method: quasi-experimental, before-and-after intervention study conducted in a public maternity hospital, Amapá. Forty-two professionals and 280 puerperal women were interviewed and data from 555 medical records were analyzed. The study was developed in three phases: baseline audit (phase 1), educational intervention (phase 2) and post-intervention audit (phase 3). Results: after the intervention, there was an increase of 5.3 percentage points (p.p.) in the normal delivery rate. Interviews with the women revealed a significant increase of the presence of companions during labor (10.0 p.p.) and of adoption of the upright or squatting position (31.4 p.p.); significant reduction of amniotomy (16.8 p.p.), lithotomy position (24.3 p.p.), and intravenous oxytocin (17.1 p.p.). From the professionals' perspective, there was a statistical reduction in the prescription/administration of oxytocin (29.6 p.p.). In the analysis of medical records, a significant reduction in the rate of amniotomy (29.5 p.p.) and lithotomy position (1.5 p.p.) was observed; the rate of adoption of the upright or squatting position presented a statistical increase of 2.2 p.p. Conclusions: there was a positive impact of the educational intervention on the improvement of parturition assistance, but the implementation process was not completely successful in the adoption of scientific evidence in normal delivery care in this institution.

RESUMO Objetivo: avaliar o impacto da implementação das práticas baseadas em evidências na assistência ao parto normal. Método: estudo de intervenção quase experimental, tipo antes e depois, conduzido em maternidade pública, Amapá. Foram entrevistados 42 profissionais, 280 puérperas e analisados dados de 555 prontuários, desenvolvidos em três fases: auditoria de base (fase 1), intervenção educativa (fase 2) e auditoria pós-intervenção (fase 3). Resultados: após a intervenção, houve incremento de 5,3 pontos percentuais (p.p.) na taxa de parto normal. Na entrevista com as mulheres, constatou-se aumento significativo da presença do acompanhante no trabalho de parto (10,0 p.p.) e da posição vertical ou cócoras (31,4 p.p.); redução significante de amniotomia (16,8 p.p.), posição litotômica (24,3 p.p.) e ocitocina intravenosa (17,1 p.p.). Na perspectiva dos profissionais, houve redução estatística da prescrição/administração de ocitocina (29,6 p.p.). Na análise dos prontuários, observou-se redução significativa da taxa de amniotomia (29,5 p.p.) e da posição litotômica (1,5 p.p.); a taxa de posição vertical ou cócoras apresentou incremento estatístico de 2,2 p.p. Conclusões: houve impacto positivo da intervenção educativa na melhora da assistência à parturiente, mas o processo de implementação não foi capaz de obter sucesso completo na adoção das evidências científicas na assistência ao parto normal nesta instituição.

RESUMEN Objetivo: evaluar el impacto de la implementación de las prácticas basadas en evidencias en la asistencia al parto normal. Método: estudio de intervención casi experimental, tipo antes y después, conducido en maternidad pública, Amapá. Fueron entrevistados 42 profesionales, 280 puérperas y analizados datos de 555 prontuarios, desarrollados en tres fases: auditoría de base (fase 1), intervención educativa (fase 2) y auditoría pos-intervención (fase 3). Resultados: después de la intervención, hubo un incremento de 5,3 puntos porcentuales (p.p.) en la tasa de parto normal. En la entrevista con las mujeres, se constató aumento significativo de la presencia del acompañante en el trabajo de parto (10,0 p.p.) y de la posición vertical o cuclillas (31,4 p.p.); reducción significante de amniotomía (16,8 p.p.), posición de litotomía (24,3 p.p.) y ocitocina intravenosa (17,1p.p.). En la perspectiva de los profesionales, hubo reducción estadística de la prescripción/administración de ocitocina (29,6 p.p.). En el análisis de los prontuarios, se observó reducción significativa de la tasa de amniotomía (29,5 p.p.) y de la posición litotomía (1,5 p.p.); la tasa de posición vertical o cuclillas presentó incremento estadístico de 2,2 p.p. Conclusiones: hubo impacto positivo de la intervención educativa en la mejora de la asistencia a la parturienta, pero el proceso de implementación no fue capaz de obtener suceso completo en la adopción de las evidencias científicas en la asistencia al parto normal en esta institución.

Healthcare quality in breastfeeding: implementation of the nipple trauma index. / Qualidade assistencial em aleitamento materno: implantação do indicador de trauma mamilar.

OBJECTIVE: assess the efficacy of the Nipple Trauma Indicator Instrument implemented in the rooming-in facility t of a university teaching hospital as a healthcare quality indicator. METHOD: exploratory, descriptive, retrospective study, with analysis of the Nipple Trauma Indicator tool of 1,691 mothers admitted in rooming-In from June to November 2012. Data were presented as absolute frequencies and percentages and statistical tests were administered. RESULTS: the mean rate of nipple trauma was 55.5%. The most frequent trauma was excoriation (62,2%) and the main cause was incorrect attachment of the newborn (44%). Maternal and neonatal factors associated with nipple trauma are also presented. CONCLUSION: the Nipple Trauma Indicator provides a picture of breastfeeding healthcare, contributing to the construction of this quality indicator.

Queda de recém-nascido internado em alojamento conjunto / Newborn falls in rooming-in care / Caída de recién nacidos internados en alojamiento conjunto

O objetivo foi descrever as ocorrências de queda de recém-nascido em ambiente hospitalar. Estudo descritivo realizado em uma maternidade pública de ensino da cidade de São Paulo. As informações foram obtidas dos registros das Fichas de Notificação de Ocorrências e prontuários dos recém-nascidos que sofreram queda no alojamento conjunto, em 2013. Foram encontrados registros de quatro quedas não intencionais de recém-nascidos, indicando uma incidência de 11,36 quedas por 10.000 nascidos vivos. Três casos ocorreram no período noturno. As consequências para os neonatos abrangem desde nenhum ferimento até lesões moderadas como edema, hiperemia em têmpora e joelho, fratura em osso parietal e hematoma, que evoluíram em boas condições. Os achados acerca das circunstâncias das quedas podem auxiliar na compreensão desses acidentes e mostram a necessidade de implantação de estratégias de prevenção das quedas que proporcionem o cuidado multiprofissional em ambiente seguro e promovam a educação da mãe, familiares e profissionais (AU).

The objective of the study was to describe occurrences of newborn falls in the hospital environment. A descriptive study was conducted in a maternity of a public, teaching hospital in the city of São Paulo. Information was obtained from records of notification sheets and medical records of newborns who suffered falls in rooming-in care in 2013. Records of four newborn unintentional falls were found, showing an incidence of 11.36 falls per 10,000 live births. Three cases occurred during the night. Consequences for neonates range from no harm to moderate injuries, such as edema, hyperemia in temples and knees, fracture of the parietal bone, and hematoma that evolved in good conditions. Findings on circumstances of falls might help understand these accidents and show the need for implementation of fall prevention strategies that provide multidisciplinary care in a safe environment and promote education of mothers, families, and professional (AU).

El objetivo fue describir los eventos de caída de recién nacido en ambiente hospitalario. Estudio descriptivo, realizado en una maternidad pública de enseñanza de la Ciudad de São Paulo. La información fue obtenida de registros de las Fichas de Notificación de Eventos e historias clínicas de recién nacidos que sufrieron caída en el alojamiento conjunto, en 2013. Fueron encontrados registros de cuatro caídas no intencionales de recién nacidos, indicando una incidencia de 11,36 caídas por cada 10.000 nacidos vivos. Tres casos ocurrieron en el período nocturno. Las consecuencias para los neonatos incluyen: ningún evento, edema, hiperemia en la sien y la rodilla, fractura del hueso parietal y hematoma, que evolucionaron favorablemente. Los hallazgos sobre las circunstancias de las caídas pueden ayudar a la comprensión de estos accidentes, y muestran la necesidad de implementar estrategias de prevención de caídas que proporcionen el cuidado multiprofesional en un ambiente seguro y promuevan la educación de la madre, familiares y profesionale (AU).

Qualidade assistencial em aleitamento materno: implantação do indicador de trauma mamilar / Calidad asistencial en la lactancia materna: implantación del indicador de trauma del pezón / Healthcare quality in breastfeeding: implementation of the nipple trauma index

RESUMO Objetivo Avaliar a adequação do instrumento Indicador de Trauma Mamilar, implantado no Alojamento Conjunto de um Hospital Universitário, como indicador de qualidade assistencial. Método Estudo exploratório-descritivo, retrospectivo, com análise do instrumento Indicador de Trauma Mamilar de 1.691 puérperas, admitidas na unidade de Alojamento Conjunto no período de junho a novembro de 2012. Os dados foram apresentados em forma de frequências absolutas e percentuais, sendo aplicados testes de associação. Resultados A média de índice de trauma mamilar foi de 55,5%, o trauma mais frequente, a escoriação (62,2%), sendo a principal causa a pega inadequada do recém-nascido (44%). Apresentam-se também os fatores maternos e neonatais que se associaram ao trauma mamilar. Conclusão O Indicador de Trauma Mamilar retrata a assistência prestada em aleitamento materno mostrando-se como uma importante ferramenta para a construção desse indicador de qualidade.

RESUMEN Objetivo evaluar la adecuación del instrumento Indicador de trauma del pezón, implementado en la maternidad de un Hospital Universitario, como indicador de la calidad. Método estudio exploratorio, descriptivo y retrospectivo; que analizó el instrumento Indicador de Trauma del pezón, en 1691 madres admitidas de junio a noviembre de 2012. Los dados fueron presentados como frecuencias absolutas y porcentajes, con pruebas de asociación. Resultados el promedio del índice de trauma del pezón fue del 55,5%, el trauma más frecuente fue la excoriación (62,2%); su principal causa, la fijación incorrecta del recién nacido (44%). Se presentaron los factores neonatales y maternos asociados con el trauma. Conclusión el instrumento Indicador de trauma del pezón retrata la atención en lactancia materna contribuyendo a la construcción del este indicador del calidad.

ABSTRACT Objective assess the efficacy of the Nipple Trauma Indicator Instrument implemented in the rooming-in facility t of a university teaching hospital as a healthcare quality indicator. Method exploratory, descriptive, retrospective study, with analysis of the Nipple Trauma Indicator tool of 1,691 mothers admitted in rooming-In from June to November 2012. Data were presented as absolute frequencies and percentages and statistical tests were administered. Results the mean rate of nipple trauma was 55.5%. The most frequent trauma was excoriation (62,2%) and the main cause was incorrect attachment of the newborn (44%). Maternal and neonatal factors associated with nipple trauma are also presented. Conclusion the Nipple Trauma Indicator provides a picture of breastfeeding healthcare, contributing to the construction of this quality indicator.

Preventing nipple trauma in lactating women in the University Hospital of the University of Sao Paulo: a best practice implementation project.

BACKGROUND: Nipple trauma in lactating women is an important issue in facilitating successful breastfeeding. Evidence suggests that early postnatal education on the positioning and attachment technique, early observation of mothers and correcting breastfeeding techniques at an early stage may reduce nipple trauma. OBJECTIVES: The aim of this project was to improve breastfeeding practice and thereby reduce nipple trauma in lactating women in a public hospital in Sao Paulo. More specifically the objectives of this project were: firstly, to assess the current practice in nurses' assistance concerning the prevention of nipple trauma; secondly, to adapt and trial a Breastfeeding Assessment Form to observe and educate the lactating mother during the early post-natal period; and thirdly, to assess the impact of introducing the assessment strategy on breastfeeding and nipple trauma rates. METHODS: The Joanna Briggs Institute Practical Application of Clinical Evidence System online tool was utilized for this project. A clinical audit was conducted to assess compliance with best practice in nursing assistance concerning the prevention of nipple trauma. The project concluded with a second audit, which assessed the change in practice following the implementation of strategies to improve practice. RESULTS: The project was successful in that there was an improvement across all of the audit criteria following the introduction of the strategy to promote best practice. Criterion 1, concerning nursing staff knowledge, improved in compliance by 73%. Criterion 2 and 4, concerning women's knowledge about prevention and management of nipple trauma, improved by 53% and 55% respectively. Breastfeeding assessment improved by 26% from baseline to follow-up audit. Moreover, an improvement in women's satisfaction and exclusive breastfeeding rates was observed; however, nipple trauma rates did not decrease. CONCLUSIONS: This implementation project had great impact on both nursing staff as well as lactating women's knowledge of preventing and managing nipple trauma. It also enhanced women's satisfaction with breastfeeding and exclusive breastfeeding rates. Further research is required into other aspects involved with the onset of nipple trauma.

Associação entre persistência de lesão de mamilos e condições de aleitamento materno / Association between persistence of nipple injury and breastfeeding conditions

O objetivo foi verificar a associação entre persistência de lesão mamilar da puérpera e condições de aleitamento materno. Os dados foram coletados no Alojamento Conjunto e na consulta pós-alta do HU-USP. Fizeram parte da amostra 60 puérperas com lesão mamilar durante a internação. Observou-se que 73,3% apresentava mamilos cicatrizados e 26,7% algum tipo de lesão. O tempo médio de cicatrização dos mamilos foi 5,6 dias. Encontrou-se associação significativa entre persistência de lesão mamilar, padrão inadequado de sucção do neonato e presença de dor mamilar. Concluiu-se que a primeira semana pós- parto é crítica, indicando necessidade de acompanhamento da puérpera. A associação entre padrão inadequado de sucção e persistência de lesão mamilar reforça a importância da assistência em aleitamento materno...

This study aimed at verifying the association between persistent nipple injury in puerperal women and breastfeeding conditions. The data was coliected at the rooming-in unit of HU- USP (University Hospital-USP) and at the time of the post- discharge consultation. The sample comprised 60 puerperal women with nipple injury while hospitalized. It was observed that 73.3% showed cicatrized nipples and 26.7% had some kind of injury. The average nipple cicatrization time was 5.6 days. A significant association was found between persistent nipple injury, inadequate suction pattern by the newborn, and the presence of nipple pain. It was concluded that the first week after labor is critical, showing the need for follow-up care of puerperal women. The association between inadequate suction pattern and persistent nipple injury highlights the importance of care in breastfeeding...

El objetivo fue el de verificar la asociación entre persistencia y lesión en los pezones de la puérpera y condiciones de la lactancia materna. Los datos fueron colectados en el Alojamiento Conjunto y en la consulta post alta dei HU-USP. Formaron parte del muestreo 60 puérperas con lesión en los pezones durante la internación. Se observó que el 73,3% presentaban pezones cicatrizados y el 26,7% algún tipo de lesión. El tiempo promedio de cicatrización de los pezones fué de 5,6 días. Se encontró asociación significativa entre persistencia de lesión en los pezones, estándar inadecuado de succión del neonato y presencia de dolor en los pezones. Se concluyó que la primera semana post parto es crítica, indicando la necesidad de un seguimiento a la puérpera. La asociación entre estándar inadecuado de succión y la persistencia de lesión en los pezones refuerza la importancia de la asistencia en la lactancia materna...

Episiotomy healing assessment: Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability.

OBJECTIVE: to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy. METHOD: observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale. RESULTS: the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88), marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46), marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42) and good agreement regarding redness (0.46< Kappa ≥0.66). For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators. CONCLUSION: the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process.

Episiotomy healing assessment: Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability / Avaliação da cicatrização da episiotomia: confiabilidade da escala REEDA (Redness, Oedema, Ecchymosis, Discharge, Approximation) / Evaluación de la curación de episiotomía: confiabilidad de la escala de Enrojecimiento, Edema, Equimosis, Drenaje, Aproximación (REEDA)

OBJECTIVE: to analyse the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) scale reliability when evaluating perineal healing after a normal delivery with a right mediolateral episiotomy. METHOD: observational study based on data from a clinical trial conducted with 54 randomly selected women, who had their perineal healing assessed at four time points, from 6 hours to 10 days after delivery, by nurses trained in the use of this scale. The kappa coefficient was used in the reliability analysis of the REEDA scale. RESULTS: the results indicate good agreement in the evaluation of the discharge item (0.75< Kappa ≥0.88), marginal and good agreement in the first three assessments of oedema (0.16< Kappa ≥0.46), marginal agreement in the evaluation of ecchymosis (0.25< Kappa ≥0.42) and good agreement regarding redness (0.46< Kappa ≥0.66). For the item coaptation, the agreement decreased from excellent in the first assessment to good in the last assessment. In the fourth evaluation, the assessment of all items displayed excellent or good agreement among the evaluators. CONCLUSION: the difference in the scores among the evaluators when applying the scale indicates that this tool must be improved to allow an accurate assessment of the episiotomy healing process. .

OBJETIVO: analisar a confiabilidade da escala REEDA (Redness, Oedema, Ecchymosis, Discharge, Approximation) para avaliar a cicatrização do períneo após parto vaginal com episiotomia médio-lateral direita. MÉTODO: estudo observacional, baseado em dados coletados em ensaio clínico, conduzido com 54 mulheres, selecionadas aleatoriamente. As mesmas tiveram o processo de cicatrização perineal avaliado em quatro momentos (de 6 horas a 10 dias após o parto), por enfermeiras treinadas para o uso da escala. O coeficiente kappa foi usado para análise de confiabilidade da escala REEDA. RESULTADOS: os resultados indicam bom nível de concordância na avaliação do item secreção (0,75< Kappa ≥0,88), concordância boa e marginal em relação ao item equimose (0,25< Kappa ≥0,42), e bom nível de concordância em relação à hiperemia (0,46< Kappa ≥0,66). O nível de concordância referente à avaliação do item coaptação diminuiu de excelente, na primeira avaliação, para bom, na última avaliação. CONCLUSÃO: a diferença entre as pontuações atribuídas pelas avaliadoras na aplicação da escala indica que o instrumento precisa ser melhorado, para permitir avaliações mais precisas do processo de cicatrização da episiotomia. .

OBJETIVO: analizar la confiabilidad de la escala de Enrojecimiento, Edema, Equimosis, Drenaje, Aproximación (REEDA) en la evaluación de la curación perineal tras parto normal con episiotomía mediolateral derecha. MÉTODO: estudio observacional con base en datos de un ensayo clínico conducido con 54 mujeres elegidas de forma aleatoria, con evaluación de su curación perineal en cuatro momentos, entre 6 horas y 10 días después del parto, por enfermeras capacitadas en el uso de esta escala. El coeficiente de kappa fue utilizado en el análisis de confiabilidad de la escala REEDA. RESULTADOS: los resultados indican buena concordancia en la evaluación del ítem drenaje (0,75< Kappa ≥0,88), concordancia marginal y buena en las primeras tres evaluaciones de edema (0,16< Kappa ≥0,46), concordancia marginal en la evaluación de equimosis (0,25< Kappa ≥0,42) y buena concordancia sobre enrojecimiento (0,46< Kappa ≥0,66). Para el ítem coaptación, la concordancia disminuyó de excelente en la primera evaluación hasta buena en la última. En el cuarto momento, la evaluación de todos los ítems mostró concordancia excelente o buena entre los evaluadores. CONCLUSIÓN: la diferencia en las notas entre los evaluadores en la aplicación de la escala indica que esta herramienta debe ser mejorada para permitir una evaluación correcta del proceso de curación de la episiotomía. .

Associação entre persistência de lesão de mamilos e condições de aleitamento materno / Association between persistent nipple lesions and breastfeeding conditions / Asociación entre la persistencia de la lesions de los pezones y las condiciones de la lactancia materna

O objetivo foi verificar a associação entre persistência de lesão mamilar da puérpera e condições de aleitamento materno. Os dados foram coletados no alojamento conjunto e na consulta pós-alta do HU-USP. Fizeram parte da amostra 60 puérperas com lesão mamilar durante a internação. Observou-se que 73,3% apresentavam mamilos cicatrizados e 26,7% algum tipo de lesão. O tempo médio de cicatrização dos mamilos foi de 5,6 dias. Encontrou-se associação significativa entre persistência de lesão mamilar, padrão inadequado de sucção do neonato e dor mamilar. Concluiu-se que a primeira semana pós-parto é crítica, indicando necessidade de acompanhamento da puérpera. A associação entre padrão inadequado de sucção e persistência de lesão mamilar reforça a importância da assistência em aleitamento materno.

The objective of this study was to verify associations between the persistence of nipple lesions in puerperae and breastfeeding conditions. The datawere collected in the Rooming-in sector at the HU-USP and a post-partum nursing consultation. Sixty puerperae presenting nipple lesions duringhospitalization were included in the study. A total of 73.3% had healed-scared nipples and 26.7% some type of lesion. The average healing timewas 5.6 days. A significant association was observed between the persistence of nipple lesions, inadequate suction patterns, and nipple pain. It wasconcluded that the first post-partum week is critical, and assistance to puerperae is needed. The association between inadequate suction patternsand nipple lesion persistence underscores the importance of breastfeeding assistance.

El objetivo de este estudio fue verificar la asociación entre la persistencia de la lesión de los pezones de la puérpera y las condiciones de la lactancia materna. Los datos fueron recogidos en el alojamiento conjunto y en la consulta post-alta del Hospital Universitario -USP. La muestra consistió en 60 puérperas con lesión de los pezones durante la internación. Se observó que el 73,3% presentaba pezones cicatrizados y el 26,7% algún tipo de lesión.El tiempo medio de cicatrización de los pezones fue de 5,6 días. Se encontró asociación significativa entre persistencia de la lesión de los pezones, patrón inadecuado de succión del neonato y dolor en los pezones. Se concluyó que la primera semana post parto es crítica, indicando necesidadde seguimiento de la puérpera. La asociación entre patrón inadecuado de succión y persistencia de lesión de pezones refuerza la importancia de laasistencia en la lactancia materna.

[Nursing contributions to the development of the Brazilian Telehealth Lactation Support Program]. / Teleamamentação no Programa Nacional de Telessaúde no Brasil: a experiência da Telenfermagem.

The National Telehealth Program was founded by the Ministry of Health, in partnership with the Ministry of Education (Ministério da Educação - MEC) and the Ministry of Science and Technology (Ministério da Ciência e Tecnologia - MCT), to support the development of family healthcare teams throughout the country. The São Paulo Telehealth Center has developed the Telehealth Lactation Support program, which provides primary healthcare professionals with information on diverse aspects of breastfeeding. This paper reports the development of the Lactation Support program and the nursing contributions. Project methodology included the formation of a multidisciplinary group of pediatricians, nurses, speech and language therapists, nutritionists, and dentists. Multimedia teaching resources were prepared for inclusion in the Cybertutor platform. Telehealth Lactation Support is an innovative and promising addition to continuing education for healthcare professionals and provides a framework for the development of other programs.

Teleamamentacão no Programa Nacional de Telessaude no Brasil: a experiência da Telenfermagem / Tele lactancia en el Programa Nacional de Telesalud en el Brasil: la experiencia de la Telenfermería / Nursing contributions to the development of the Brazilian Telehealth Lactation Support Program

O Programa Nacional de Telessaúde é uma ação do Ministério da Saúde, em parceria com o Ministério da Educação (MEC) e o Ministério da Ciência e Tecnologia (MCT), e tem como proposta a qualificação das equipes de saúde da família em todo país. Nessa perspectiva, o Núcleo São Paulo de Telessaúde desenvolveu a Teleamamentação, que tem como meta proporcionar aos profissionais da atenção primária informações sobre diversos aspectos da amamentação por diferentes profissionais da área da saúde. Este trabalho tem por objetivo relatar a experiência da Teleenfermagem na Teleamamentação do Programa Nacional de Telessaúde no Brasil no Núcleo São Paulo. Como metodologia de trabalho adotou-se a criação de um grupo multidisciplinar composto por pediatras, enfermeiras, fonoaudiólogas, nutricionistas e dentistas. Foram elaborados materiais didáticos multimídia inseridos na plataforma Cybertutor. Vislumbra-se a Teleamamentação como uma estratégia inovadora e promissora por permitir um impacto relevante na educação permanente de profissionais da saúde.

El Programa Nacional de Telesalud es una acción del Ministerio de Salud, en colaboración con el Ministerio de Educación (MEC) y el Ministerio de Ciencia y Tecnología (MCT), y tiene como propuesta capacitar a los equipos de salud de la familia en todo el país. Desde esta perspectiva, el Núcleo Sao Paulo de Telesalud desarrolló la tele lactancia, que tiene como meta proporcionar a los profesionales de atención primaria, informaciones sobre diversos aspectos de la lactancia materna, por diferentes profesionales del área de la salud. Este trabajo tiene por objetivo relatar la experiencia de la Teleenfermería en la tele lactancia del Programa Nacional de Telesalud en el Brasil, en el Núcleo Sao Paulo. La metodología de trabajo adoptada fue la creación de un grupo multidisciplinario compuesto por pediatras, enfermeras, fonoaudiólogas, nutricionistas y odontólogos. Fueron elaborados materiales didácticos multimedia incluidos en la plataforma Cybertutor. Se vislumbra la Tele lactancia como una estrategia innovadora y prometedora por permitir un impacto significativo en la educación continuada de los profesionales de la salud.

The National Telehealth Program was founded by the Ministry of Health, in partnership with the Ministry of Education (Ministério da Educação – MEC) and the Ministry of Science and Technology (Ministério da Ciência e Tecnologia – MCT), to support the development of family healthcare teams throughout the country. The São Paulo Telehealth Center has developed the Telehealth Lactation Support program, which provides primary healthcare professionals with information on diverse aspects of breastfeeding. This paper reports the development of the Lactation Support program and the nursing contributions. Project methodology included the formation of a multidisciplinary group of pediatricians, nurses, speech and language therapists, nutritionists, and dentists. Multimedia teaching resources were prepared for inclusion in the Cybertutor platform. Telehealth Lactation Support is an innovative and promising addition to continuing education for healthcare professionals and provides a framework for the development of other programs.

Necessidades de saúde de nutrizes e qualidade de vida / Health needs and quality of life of nursing mothers

OBJETIVO: Relacionar as necessidades de saúde e a qualidade de vida de nutrizes. MÉTODOS: Estudo transversal com 219 nutrizes selecionadas por amostra consecutiva de conveniência. O instrumento de pesquisa utilizado foi o WHOQOL-bref. RESULTADOS: O não atendimento das necessidades de saúde das nutrizes esteve associado às menores médias de qualidade de vida, com diferença estatística significativa: no domínio Físico, para mulheres com necessidade de sono e repouso, apoio familiar e tempo para si; no domínio Relações Sociais, para mulheres com necessidade de apoio familiar; no domínio Meio Ambiente, para aquelas com necessidade de acesso aos serviços de saúde, ambiente adequado para amamentar e apoio profissional; no domínio Psicológico para nutrizes com necessidade de ter boa saúde mental. CONCLUSÃO: As nutrizes com necessidades de saúde não supridas apresentaram média de qualidade de vida inferior.

OBJECTIVE: Establish a relationship between nursing mothers' health needs and their quality of life. METHODS: Cross-sectional study with 219 nursing mothers selected by consecutive convenience sampling. The assessment instrument WHOQOL-bref was used in this study. RESULTS: A significant statistical difference was found between the non-satisfaction of the nursing mothers' health needs and a lower mean quality of life score as follows: in the physical domain, for women who needed sleep and rest, family support and time for themselves; in the social relationships domain, for women who needed family support; in the environment domain, for those who needed access to health services, an appropriate environment to breastfeed and professional support; in the psychological domain, for mothers who needed good mental health. CONCLUSION: Nursing mothers with unsatisfied health needs presented a lower mean quality of life score.

Necessidades de saúde de mulheres em processo de amamentação / Health needs of women in breastfeeding process

Considerando-se os benefícios do aleitamento, amplamente reconhecidos, e as baixas taxas de aleitamento materno exclusivo no Brasil e que a mulher é o elemento que decide os rumos da amamentação, buscou-se nesse estudo o levantamento de necessidades de saúde a partir do depoimento de mulheres sobre a sua experiência de amamentar, pois na visão do profissional de saúde, a assistência geralmente se baseia no atendimento das demandas que chegam ao serviço. Os objetivos traçados para este estudo foram: identificar as necessidades de saúde de mulheres atendidas em uma Unidade Básica de Saúde no município de São Paulo, no processo de aleitamento materno; relacionar as necessidades de saúde identificadas com o perfil socioeconômico, demográfico e obstétrico dessas mulheres; relacionar as necessidades de saúde identificadas com a situação de aleitamento materno dessas mulheres. Participaram do estudo 238 mulheres, que realizaram entrevistas semi-estruturadas sobre a sua experiência de amamentar. Os dados foram organizados segundo a proposta do Discurso do Sujeito Coletivo, extraindo-se as expressões-chave e as ideias centrais dos depoimentos, que foram trabalhados em uma abordagem qualitativa e quantitativa. As necessidades de saúde das mulheres para a manutenção do aleitamento materno, classificadas de acordo com a taxonomia de Matsumoto foram: Necessidade de boas condições de vida (ter uma boa alimentação; trabalhar ou estudar; ter tempo para si; ter sonoe repouso adequados; ter boa saúde mental; ter boas condições para amamentar seu filho - ter boa produção de leite, ter apoio instrumental e/ou afetivo da família, ter ambiente adequado em casa para amamentar); Necessidade de ter acesso a todas as tecnologias de saúde que contribuam para melhorar e prolongar a vida (lidar com as intercorrências da amamentação, ter acesso aos serviços de saúde para seguimento após a alta); ) Necessidade de ter vínculo com um profissional ou equipe de saúde; Necessidade de autonomia e autocuidado na escolha do modo de andar a vida (ter orientação quanto ao aleitamento materno, no pré-natal e na internação; receber apoio instrumental e/ou afetivo do profissional; se sentir segura com relação à amamentação). As necessidades que apresentaram associação estatística significativa com a situação de aleitamento foram: ter uma boa alimentação, ter boa produção de leite, ter vínculo com um profissional ou equipe de saúde e se sentir segura com relação à amamentação. As variáveis socioeconômicas e demográficas que apresentaram associação estatística significante com algumas necessidades de saúde foram a escolaridade, renda familiar e idade da criança. Quanto às variáveis obstétricas, observou-se associação estatística significante com local do pré-natal, local do parto, tipo de parto, paridade, prematuridade da criança e peso da criança ao nascer. Com os resultados desse estudo pretende-se colaborar para melhorar a efetividade daproteção, promoção e apoio ao aleitamento materno, promovendo o atendimento das necessidades de saúde das nutrizes durante o processo de amamentação.

Considering the benefits of breastfeeding, widely recognized, and the low rates of exclusive breastfeeding in Brazil and that the woman is the element who decides the course of breastfeeding, this study sought to survey the health needs from the testimony of women about their experience of breastfeeding, therefore on the vision of the health professional, the assistance generally is based on the attendance of the demands that come to the health service. The aims of this study were: to identify the health needs of women seen at a Basic Health Unit in the city of São Paulo, in their breastfeeding process; to relate the identified health needs with the social, economic, demographic and obstetric profile of these women; to relate the identified health needs with the breastfeeding situation of these women. Study participants were 238 women who underwent semi-structured interviews about their experience of breastfeeding. The data had been organized according to proposal of the Collective Subject Discourse, extracting the expression-keys and the central ideas of the depositions, which had been analyzed in a qualitative and quantitative methodological approach. The health needs of the women for the maintenance of the breastfeeding classified by the taxonomy of Matsumoto had been: Necessity of good conditions of life (to have good alimentation; to work or to study; to have time for itself; to have sleep and adequate rest; to have good mental health; to have goodconditions to breastfeed the baby - to have good milk supply, to have instrumental and/or affective support of the family, to have environment adjusted at home to breastfeed); Necessity to have access to all the health technologies that contribute to improve and to draw out the life (to deal with the breastfeeding problems, to have access to the services of health for follow-up after discharge); Necessity to have bond with a professional or health team; Necessity of self-care and autonomy and in the choice in the way of walking the life (to have orientation about breastfeeding, in the prenatal appointments and in the maternity ward; to receive instrumental and/or affective support from the professional; to feel self-confident with regarding to breastfeeding). The necessities that had presented statistically significant association with the breastfeeding situation had been: to have good alimentation, to have good milk supply, to have bond with a professional or health team and to feel self-confident with regarding to breastfeeding. The social, economic and demographic variables that had presented a statistically significant association with some health needs had been the education level, familiar income and age of the child. Regarding obstetric variables, a statistically significant association was observed with place of prenatal, the place of birth, type of delivery, parity, premature child and child\'s weight at birth. With the results of this study it isintended to collaborate to improve the effectiveness of the protection, promotion and support to breastfeeding, promoting the attendance of the health needs of the lactating women during the breastfeeding process.